Estonia 2014 – visit to Cardiff


The Estonia project is going excellently.  This page includes a report from a visit from our Estonial collegues this spring; in summary the objectives of our exchange were fully met and we have good feedback from both teams.

We completed a very positive return visit this autumn despite a key team member leaving and having to be replaced at the last minute.  We will be posting a more detailed report on that visit later.

Introduction, Spring 2014 visit

This report outlines the visit to Cardiff University Hospital on 30th March – 5th April 2014 by two Estonian Doctors. The objectives of the visit were

  • To provide and encourage a link between CF practitioners in Estonia and the CF team at Cardiff University Hospital.
  • To facilitate visits by Estonian Practitioners to the UK, in order that they can see first-hand ‘best practice’ in the UK.
  • To facilitate the visit of UK practitioners to Estonia, to provide education on UK practice to Estonian medical personnel.


Following the successful visit of Dr Iolo Doull in January 2009, the Estonian project somewhat ground to a halt with both the Estonian and Welsh teams being etrememly short staffed and busy. Fortunately, earlier this year, Tony Wolstenholme managed to re-establish contact with the two Estonian Doctors, Dr Urve Putnik and Dr Marie Vasar, and to make a connection with a new lead contact at Cardiff University Hospital, Dr Julian Forton.

In line with the previously discussions carried out in Estonia in 2009, a visit was arranged for the Estonian Doctors to visit Cardiff for a week. This visit took place from the 31st of March until 5th April this year. Katy Toms took over from Tony as Project Manager for the Estonian Project on the 31st March.

Team and Programme

Cardiff Team

Consultants Dr Iolo Doull, Dr Julian Forton (lead contact), Dr Lena Thia

Dieticians Claire Mott, Viv Jones

Physiotherapists Jo-dee Tame, Kath Ronchetti

Sleep Physiologist Nicola Stonely

Visiting Doctors

Dr Urve Putnik – Children’s Hospital Tallinn, Estonia
Dr Marie Vasar – Tartu University Hospital, Estonia

Project Manager

Katy Toms – CHI



9.00 Patient discussion followed by ward round
12.30 Departmental X-ray meeting
14.00 Respiratory clinic (non-CF)


8.30 Sleep Medicine ward round
9.30 CF clinic (12 patients)
14.00 CF meeting


Meeting with Adult CF Team


8.45 CF pre clinic meeting 9:00 Teaching with Iolo
9.30 Meeting with Dietician
9.45 CF annual assessment clinic
14.00 – CF outreach clinic (Aberdare)

Friday – State-of-the-Art Educational Symposium on Cystic Fibrosis

Session 1: Pathophysiology and CFTR directed therapies
09:30 CFTR dysfunction – Prof Jane Davies, Imperial College, London
10:00 Gene therapy – Prof Eric Alton, Imperial College, London
10:30 Drug discovery – Dr Fredrick Van Goor, Vertex Pharmaceuticals
11:00 Small molecules – Prof Stuart Elborn, Queen’s University, Belfast

Session 2: Microbiology
12:00 Microbiome analysis – Prof LiPuma, University of Michigan
12:30 Emerging pathogens – Dr Andres Floto, University of Cambridge

Session 3: Advances in clinical care

14:00 Imaging – Dr Michael Puderbach, University of Heidelberg, Germany
14:30 Adherence interventions – Prof Kristin Riekert, Johns Hopkins, Baltimore

Session 4: Looking to the future
15:30 Artificial lungs and lung transplantation – Mr Steven Tsui, Papworth Hospital, Cambridge
16:00 Future models of care – Dr Caroline Elston, Kings College Hospital, London


Dr Urve Putnik & Dr Marie Vasar

  • The trip was a really positive experience, the staff in Cardiff were all very kind and welcoming.
  • It was very useful to be able to talk with experienced Doctors on a case by case basis and then to be able to relate that to similar cases in Estonia. These discussions were very helpful for our treatment of patients in Estonia.
  • We were very impressed with the teamwork of the Cardiff team. All of the staff were aware of what was going on with every patient. We got many useful ideas from observing this.
  • Observing Iolo teaching and discussing research papers was also very valuable.
  • We feel the first priority for a return visit would be from a physiotherapist. Inhalation techniques in Estonia are currently undertaken by Nursing staff and we would very much like a physiotherapist to come to Estonia to demonstrate what you do here.
  • It would also be beneficial for a Dietician to visit.  However because resources are different in Estonia this may not work so well.
  • We are also very interested in the idea of a pilot study in neo-natal screening possibly in combination with Latvia. We would like to be included if CHI organise a meeting in Riga.

Dr Julian Forton

  • We enjoyed having the two Estonian Doctors in Cardiff.
  • Sharing ideas about MDT input, structure of clinic services for infection control and development of adult services were probably useful for them.
  • I have spoken with Jodee (Physiotherapist) who is keen. I have not spoken with a dietician yet – their work might be more limited by the resources/feeds available locally and may be less immediately tranferable – but still probably very useful.

Conclusions & Recommendations

This was a highly successful visit and both the Cardiff team and the two Estonian Doctors found it very valuable and would like the link to continue. As a result of the feedback given and the previous history of the project I would like to make the following recommendations.

  • That a date for a return visit be arranged as soon as possible to avoid the project going into hiatus again. October has been suggested as a possible return date.
  • That CHI offer to support a visit to Estonia of a physiotherapist at the least and maybe a dietician as well. (Dr Forton has also asked whether a Doctor should go, I have yet to hear back from Estonia about that idea)
  • In the event that a Pilot project for Neo-natal Screening is undertaken in Latvia, we keep the Estonian’s informed and attempt to promote their co-operation/inclusion in such a project.